{% load i18n %}
<form class="form" id="profileForm" method="POST">
	{% csrf_token %}
	<fieldset>
		<div class="row">
			<div class="col-md-3">
				<div class="form-group">
					<label class="control-label" for="name_id">{% trans "Name" %}</label>
					<div class="controls">
						<input type="text" class="form-control enter-enable" id="name_id" name="name" value={{user.userprofile.name}}>
					</div>
				</div>
			</div>
			<div class="col-md-3">
				<div class="form-group">
					<label class="control-label" for="gender_id">{% trans "Gender" %}</label>
					<div class="controls">
						<input type="hidden" id="gender_id" name="gender" class="enter-enable" style="display:none" value={{user.userprofile.gender}}>
						<select class="form-control selectpicker" id="gender_select">
							<option selected="selected" value="Male">{% trans "Male" %}</option>
							<option value="Female">{% trans "Female" %}</option>
						</select>
					</div>
				</div>
			</div>
		</div>
		<div class="row">
			<div class="col-md-3">
				<div class="form-group">
					<label class="control-label" for="pid_id">{% trans "Personal id" %}</label>
					<div class="controls">
						<input type="text" class="form-control enter-enable" id="pid_id" name="pid" value={{user.userprofile.pid}}>
					</div>
				</div>
			</div>
			<div class="col-md-3">
				<div class="form-group">
					<label class="control-label" for="bday_id">{% trans "Birthday" %}</label>
					<div class="controls">
						<input type="date" class="form-control enter-enable" id="bday_id" name="bday" value={{user.userprofile.bday|date:"Y-m-d"}}>
					</div>
				</div>
			</div>
		</div>
		<div class="row">
			<div class="col-md-3">
				<div class="form-group">
					<label class="control-label" for="phoneNum_id">{% trans "Phone Number" %}</label>
					<div class="controls">
						<input type="text" class="form-control enter-enable" id="phoneNum_id" name="phoneNum" value={{user.userprofile.phoneNum}}>
					</div>
				</div>
			</div>
			<div class="col-md-3">
				<div class="form-group">
					<label class="control-label" for="country_id">{% trans "Nationality" %}</label>
					<div class="controls">
						<input type="hidden" id="country_id" class="form-control enter-enable" name="nationality" style="display:none" value={{user.userprofile.nationality}}>
						{% include "component/country-selector.html" %}
					</div>
				</div>
			</div>
		</div>
		<div class="row">
			<div class="col-md-3">
				<div class="form-group">
					<label class="control-label" for="emgcyContact_id">{% trans "Emergency contact person" %}</label>
					<div class="controls">
						<input type="text" class="form-control enter-enable" id="emgcyContact_id" name="emgcyContact" value={{user.userprofile.emgcyContact}}>
					</div>
				</div>
			</div>
			<div class="col-md-3">
				<div class="form-group">
					<label class="control-label" for="emgcyContPhone_id">{% trans "Emergency contact person's phone number" %}</label>
					<div class="controls">
						<input type="text" class="form-control enter-enable" id="emgcyContPhone_id" name="emgcyContPhone" value={{user.userprofile.emgcyContPhone}}>
					</div>
				</div>
			</div>
		</div>
		<div class="row">
			<div class="col-md-3">
				<div class="form-group">
					<div class="controls">
						<a class="btn btn-info" id="profile_modify">{% trans "Modify" %}</a>
						<img id="ajax_wait_img" src="{{STATIC_URL}}img/loading.gif" height="30 px" width="30 px" style="display:none"/>
					</div>
				</div>
			</div>
		</div>
		<div class="row" id="profile_form_errormsg" style="display:none">
			<div class="col-md-12">
				<div class="alert">
					<span class="msg"></span>
				</div>
			</div>
		</div>
	</fieldset>
</form>